The last 2-3 years,with the hormones, non many interests e.t.c. I have gained a lot of weight ... my BMI is almost 40      so a surgeon I have sceduled to do SRS said that my BMI  has to be 32...
But I ca'nt lose weight!! It is too difficult for me psychologicaly and with the reaction of hormones & some antidepressants... So do you know any surgeon who does SRS no matter the weight you are??? Thnx!!! (Greece Here) 

If you're very heavy, then your body is already under a lot of stress. It's really hard work for the heart to pump blood through a bmi 40 body.
This means that surgical and post surgical complications are far more dangerous for your body than it is for one that is more proportionate, weight and height wise. It also means that you are at a much higher risk of getting surgical and post surgical complications.

In short, it means that your body isn't going to handle surgery well, and even something like this could easily lead to your death.

That's why it's so important to loose weight for SRS.
And not just SRS, but for life.

There are little things you can do to loose weight. You need to do this carefully, because, as I said, your body is already very stressed.
Little things are like;
Switch to plain water instead of sodas/sweetened drinks.
Switch to dark chocolate (60% or darker) instead of other "treats". One little piece of dark chocolate has more flavor than a whole bar of milk chocolate.
Read the ingredients list of everything you buy and remember, it's organized by amount (this means, the first thing on the list is what there is most of in the container, the second is what is second most of in the container, and so forth..) so if sugar is one of the first 3-4 things, it's not "fit for consumption".
Make your own food and treats. (If you know exactly what you've put into the food then you automatically eat better.) Pre-fabricated and highly processed food can contain sickening amounts of sugar and salt.

And lastly,.. walk
You don't have to walk far, just as much as you're comfortable with.
You can always walk further tomorrow.
At 40 bmi, you will burn more energy in a ten minute slow walk than I (at bmi 27) will burn in a half hour brisk walk. Set your own pace.

If you want to have your surgery, and survive it, and "live" after it, it's up to you to change your life a little bit to make that possible.

I know it's tough, but the truth is, it's not about how you look, it's about your health, your life.

*offers a hug*

its not just srs surgeons who will refuse to operate on persons of this size regular surgeons will too unless they have absolutely no choice. the reason is your chances of not surviving the surgery are extreamly high.
jessica

One would think that SRS is psychologically motivating enough to lose weight. I mean if it isn't, then what is?

Thankfully in the UK the surgeons seem to be slightly less obsessed with this. I know this because 25 years or so after my first op I am currently considering a minor cosmetic revision and I have indeed asked the question.

It did make me giggle though when someone described a BMI of 32 as being morbidly obese - Sorry but my BMI is actually also 32 and I can tell you that I have no "issues with mobility" nor do I regard that as morbidly obese - I'm a bit overweight yes - but obese only if you believe the claptrap.

I do not wear grossly outsized clothes - (I'm size 18/20) I also have very low chloresterol and a BP of 120/60 which brilliant for someone in their 50's

It's well known, and indeed reasonably widely acknowledged even by doctors in the UK, that the BMI scale is not always helpful because there are other factors - like bone density and other things which affect weight and can skew the result.

My own doctor is quite adamant that I am indeed NOT obese - even though the BMI scale begs to differ. In fact he says I'm in pretty good shape. So don't necessarily believe all this thinist propaganda. You don't want to be huge - but BMI of 32 aint huge by a long shot!

BMI has been recognized as not being particularly realistic when it comes to how obese someone is. It has some limitations because it doesn't take into account how active someone is and other things. It's just a height/weight calculation. Unfortunately, it gets used a lot. If your surgeon is using it, there's probably not much you can to to help that. Your doctor is probably using it as a CYA (cover your ...) But as others have said, there is a correlation to your weight and how well you heal after surgeries.

Miniar has given you good advice for easy ways to lose weight. I'd like to add to it and say:

- eat more fruits and veggies! Like 5-8 servings/day. More veggies fill you up and last longer (so you don't get hungry). Fruit has sugar, so try not to eat just fruit.

- eat lean protein. Chicken, fish, pork, and lean ground beef (7% fat), are all good choices. Combine carbs (breads/starches) with protein and you'll stay fuller longer.

- get nutrition facts. Most restaurants post nutrition info on their websites. If you're going out to eat, compare the choices before going so you can make *good* choices. As an example, most restaurant salads have as many calories as a hamburger. Not such a good choice. As a rule of thumb - high calories and fat is bad. Less calories and low fat and high fiber is better.

The last thing to remember is that it took time to put the weight on, it's going to take time to lose it. But you *can* lose it, and it doesn't take much to get started

Good luck!

WR

QuoteAnd lastly,.. walk

Yes! It's good for the body and great for the soul. Go ahead and splurge on a nice mp3 player to keep it interesting and get out there. I'd rather have a vagina than a cupcake any day.

It's largely an actuarial deal.  All surgeries are dangerous.  At some point the excessive body weight issue makes it even more dangerous.  Such morbidity tables are kept by every insurance company, and they in turn make their clients - the doctors - aware of them. There is point at which the insurance company is pretty much going to draw a line and say, 'you can't go over that rate.'  Actually, they are going to say, usually in the contract, 'you will not be insured for surgeries where the rate of failure goes over X%.'  So the doctor could do it, but I doubt many would without liability (malpractice) insurance. 

Quote from: Matilda on November 20, 2009, 05:29:20 PMI'm not surprised, really.  If you're morbidly obese, most (if not all) surgeons will refuse to operate.  Losing weight before SRS is important; otherwise, it might take you longer to recover because of limited mobility which in turn can cause phlebitis, severe bleeding, infection & other complications.

This.  It also decreases the likeliness for complications with the anaesthesia.

That said, I had no idea what my pre-chest surgery BMI was, but I'm sure it was pretty high and furthermore, I had so much weight on my chest that simply laying down on my back suffocated me, and that was so much pressure on my spine that physical activities typically employed for weight loss were off the table.  Basically, for exceptions to be made, a patient's liklihood for increased mobility post-op must be high -- which is why there are few (if any) BMI limits for, say, a gastric bypass, and why breast reductions (and by proxy, FTM chest recon -- provided enough pre-op tissue is present, of course) typically get a pass on this because the potential to lose weight after the surgery is significantly increased.

Short of either a) increasing one's activity to lose weight (even taking a walk one or two times a day tends to help, seriously), or seeking bariatric procedures first (I know one TS woman local to me who took that route), there's not really any convincing argument you can make to most doctors.  Yes, some doctors don't care and will be willing to do it anyway, but certain post-op complications significantly increase when one is heavier.

It's true that BMI is not very indicative of this "heaviness" -- at his peak, the athlete Michael Jordan had a BMI of 36, and it would be impossible to find a doctor who would refuse him a procedure in his athletic condition.  So if you even admit that you're not very active, and it clearly shows in your body's condition, that says more about your post-operative mobility and yes, that can have the potential to decrease healing time which, in turn, will increase potential for infections.

BMI is just one tool, used in conjunction (but not by itself) with the more classic height/weight tables. It was created because the H/W by itself can not compensate for heaver bone structure, or in the case of Michael Jordon, almost pure muscle mass.

I would be *really* careful with the bariatric surgeries, i.e. gastric bypass and the lapband. They have high mortality rates and also high incidence of weight regain. The reason? The patient never learns how to eat healthy. Weight Watchers is littered with people who have had one of the above surgeries and have lost 100lbs + and then gained 100lbs++ back. Not worth it in my opinion.

WR

And last piece of advice.

And I can't stress this one enough.

DO NOT GO ON A DIET!
Make changes in your life/lifestyle.
Permanent changes!
Not temporary!

Sometimes when they have BMI or weight standards they have ways to get by it,  not sure if it would work in your case. For instance when I was in the military if you were over your weight limit but were mostly muscle (the Micheal Jordan scenario) they would do a body fat test and if you had a low body fat % they waved the weight requirement. As they weigh you for physicals even after you have enlisted. As everyone else said its just so you have a better recovery and less chance of complications. Maybe if you lose some then could do a body fat test and use that.
Good Luck
Andrew